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E/e predicts exercise capacity and adverse cardiovascular outcomes in patients with chronic kidney disease

Session Stress echocardiography in 2020

Speaker Gary Gan

Event : EuroEcho 2019

  • Topic : imaging
  • Sub-topic : Stress Echocardiography
  • Session type : Rapid Fire Abstracts

Authors : G Gan (Sydney,AU), K Kadappu (Sydney,AU), A Bhat (Sydney,AU), F Fernandez (Sydney,AU), H Chen (Sydney,AU), S Eshoo (Sydney,AU), L Thomas (Sydney,AU)

G Gan1 , K Kadappu2 , A Bhat1 , F Fernandez1 , H Chen1 , S Eshoo1 , L Thomas3 , 1Blacktown Hospital , Department of Cardiology - Sydney - Australia , 2Liverpool Hospital, Department of Cardiology - Sydney - Australia , 3Westmead Hospital, Department of Cardiology - Sydney - Australia ,

On behalf: NA

Stress Echocardiography

Background: Patients with chronic kidney disease(CKD) have reduced physical fitness that contributes to the disproportionately elevated risk of cardiovascular disease in this population. Our aim was to assess the association between E/e’ and exercise capacity in CKD patients and the prognostic role of E/e’.

Methods: Patients with Stage 3/4 CKD, without previous cardiac disease were prospectively recruited. Recruited patients underwent transthoracic echocardiogram and exercise stress echocardiogram with assessment of exercise E/e’. Patients were compared, one to one, to age, gender and risk factor matched controls and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular events (MACE). Exercise capacity was assessed as metabolic equivalents (METs) with reduced exercise capacity defined as METS of =7. Raised exercise E/e’ was defined as exercise E/average e’ of >13.

Results: 156 CKD patients (62.8±10.6 yrs, male 62%) were compared to 156 matched controls. CKD patients had higher rates of anemia (p<0.01), larger left ventricular indexed mass (p<0.01), larger LAVI (p<0.01) and higher resting (p<0.01) and exercise E/e’ (p<0.01). Overall, CKD patients achieved lower METs (p<0.01) with exercise and a greater proportion of CKD patients had METs =7 (p<0.01). Receiver operating curves (Figure1) showed exercise E/e’ (AUC 0.89, CI 0.84-0.95, p<0.01) to be the strongest predictor of reduced exercise capacity in CKD patients. Exercise E/e’ of >13 was also associated with higher rates of cardiovascular death and MACE amongst CKD patients.

Conclusion: Exercise E/e’ is a strong predictor of exercise capacity amongst CKD patients, who commonly have reduced exercise capacity presumably consequent to diastolic dysfunction. Raised exercise E/e’ in CKD patients is predictor of cardiovascular death and MACE.

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